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Blood Parameters (Meister Et Al 2011)
Blood Parameters (Meister Et Al 2011)
Affiliation University of Saarland, Institute of Sports and Preventive Medicine, Saarbrücken, Germany
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Key words Abstract fere with clinical decisions in soccer players.
●
▶ athletes ▼ Upper limits of the 95 % confidence intervals
●
▶ exercise
Often blood screening is repeatedly done in elite exceeded population reference ranges slightly in
●
▶ reference range
athletes although training and competition can AST, urea, creatinine, and potassium. The mean
●
▶ plasma volume
affect its results and normal ranges for highly intraindividual coefficient of variation was below
●
▶ variability
active individuals are widely unknown. This 10 % in complete blood count (except leukocytes),
study was conducted to provide reference data in creatinine, uric acid, total cholesterol, and all
professional soccer players. 467 male soccer electrolytes. There seems to be a profound effect
players of the 2 highest German leagues were of elite soccer training and competition on hema-
observed over an entire season. Venous blood tocrit (plasma volume) and CK only. Spontaneous
sampling was conducted 4 times in a standard- variability of most parameters is too small to jus-
ized manner to determine complete blood count, tify repeated sampling only for routine screening.
AST, ALT, CK, creatinine, urea, uric acid, choles-
terol, electrolytes, ferritin, CRP and TSH. Trial Registration: NCT00946855
There were significant changes during the season Effect of Elite Soccer Training on Routine Labora-
in hematocrit, creatinine, uric acid (decrease), tory Parameters (SOCCERLAB), http://www.clini
CK, AST, urea, sodium, potassium, magnesium, caltrials.gov/ct2/show/NCT00946855?term = soc
and TSH (increase). Only the changes in hemato- cerlab&rank = 1
crit and CK were large enough to possibly inter-
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
876 Clinical Sciences
B 18 19 22
C 18 20 21 Blood sampling and processing
D 6 21 10 Samples were taken by an experienced phlebotomist (either the
E 2 14 15
team physician or one of the investigators) in the morning (08.00
F 16 23 21 25 10
to 11.00 a. m.) after overnight fasting from an antecubital vein in
G 15 24 20 1 1
the supine position. Samples were divided into 2.7 ml EDTA
H 21 24 25 24 11
I 9 blood for the blood count and 9 ml whole blood (serum gel
J 18 20 18 tubes). Whole blood was centrifugated within 20 min after sam-
K 15 21 1 pling and serum separated from the other compounds for all
L 24 21 5 17 further determinations. Players had to fill in questionnaires
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M 19 about their present health condition and other factors possibly
N 21 21 interfering with the determination and/or interpretation of the
O 26 27 24 24 18 blood parameters.
P 23 19 They covered
Q 22 27 21
▶ infections and other internal diseases within the last 4 weeks
R 16 22 20
▶ intramuscular injections within the last 2 weeks
total 216 323 240 187 40
▶ diets within the last 2 weeks
▶ drug and supplement intake over the last 2 weeks
large sample of one of the most competitive leagues in the world. ▶ information about individual training on the sample days and
Therefore, these athletes might delineate the upper limit of train- the 2 preceding days (team training information provided by
ing-induced changes in laboratory parameters. It was intended to the medical staff)
describe the course of common blood variables over one season ▶ information about food/fluid intake on the sample day
and, thus, to detect the effects of continuous physical strain. These questionnaires were provided in German, English, French,
Spanish, and Italian. All samples were handled within a single
laboratory (underlying external quality control 4 times per year
Materials and Methods according to German law as well as daily internal control). Trans-
▼ port of cooled EDTA blood and serum was either carried out by
All procedures were in accordance with ethical standards of the car (investigators themselves) or by a commercial transport
Helsinki Declaration from 1975 and the journal guidelines as service that guaranteed uninterrupted cooling.
outlined in [13]. The study was approved by the local ethics
committee (Ärztekammer of Saarland, Saarbrücken, Germany). Blood parameters and determination methods
Manuscript preparation was made in accordance with the From EDTA blood a complete blood count was made (Sysmex
STROBE statement. K-1000, Sysmex, Norderstedt, Germany) including erythrocyte,
leukocyte, lymphocyte, and thrombocyte counts, hemoglobin,
Subjects and hematocrit. From serum, the following parameters were
All clubs of the 2 first German professional soccer leagues determined (determination method; intra- and inter-assay coef-
(males) and their team physicians were invited to participate in ficient of variation in parentheses):
this study by an official letter from the head organisation Deut- aspartate-amino-transferase [AST] – (enzyme activity measure-
sche Fußball Liga (DFL) and, in addition, by e-mail from the first ment, AST, MDH, optical test; 3.5 %; 5.3 %)
author. 17 of 36 clubs (plus 1 club from the third league which alanine-amino-transferase [ALT] – (enzyme activity measure-
went down one season before study onset and maintained its ment, ALT, LDH, optical test; 3.5 %; 5.3 %)
training schedule) agreed to participate. This led to the inclusion creatine kinase [CK] – (enzyme activity measurement, CK, HK,
of 532 players (52 % of the registered players during the season G6PDH, optical test; 3.5 %; 5.3 %)
2008/09). To be eligible for professional soccer in Germany, all creatinine – (Jaffé method, kinetic measurement; 3 %; 4.5 %)
players have to pass a defined pre-season medical screening urea – (urease-GLDH-UV-test; 3 %; 4.5 %)
examination that is designed to rule out relevant internal and uric acid – (uricase method according to Trinder; 2 %; 3 %)
orthopedic diseases. In addition to this, club physicians were total cholesterol – (entirely enzymatic method according to
asked not to include players with known diseases (e. g., rheu- Trinder; 3 %; 4.5 %)
matic diseases, diabetes mellitus). A questionnaire to be filled in HDL-cholesterol – (photometry, 2nd and 3rd generation; 3 %; 4.5 %)
from all players before each sample completed the medical LDL-cholesterol – (photometry, 3rd generation; 2 %; 3 %)
screening procedures to ensure sufficient health status for par- sodium – (potentiometry, ion-selective electrode; 1 %, 1.5 %)
ticipation. Each player was informed about the requirements of potassium – (potentiometry, ion-selective electrode; 2 %; 3 %)
the study and they gave informed consent. magnesium – (photometry of magnesium complexes, Calmagit;
2 %; 3 %)
General design ferritin – (enzyme immunoassay; 3.6 %; 4.3 %)
Players were asked to give a venous blood sample at 4 times dur- C-reactive protein – (immune turbidimetry; CRP; 5 %; 7.5 %)
ing the 2008/09 soccer season. The following sampling times
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
Clinical Sciences 877
thyroid-stimulating hormone [TSH] – (enzyme immunoassay; the reasons for eliminations. Anthropometric data of the remain-
2.5 %; 4.6 %) ing 467 players (45 % of the registered players during the season
Reference ranges were adopted from the national standard text- 2008/09) were: age 24.9 ± 4.4 years; height 1.83 ± 0.07 m; weight
book [36]. No such ranges are presented for total cholesterol and 78.7 ± 9.6 kg; BMI 23.6 ± 6.9 kg/m2.
its subfractions because target values (in the context of cardio-
vascular risk management) are more meaningful than popula- Median values, 95 % confidence intervals,
tion means for the evaluation of blood lipids. Certain parameters intraindividual variability
were excluded from analysis whenever one of the following con- ●▶ Fig. 2 displays the course of erythrocyte count, hemoglobin,
founders was present: and hematocrit values together with 95 % confidence intervals.
infection – leukocytes, CRP, ferritin CK results are shown in ●▶ Fig. 3. All other parameters are listed
intramuscular injection – CK in ●
▶ Table 2 together with their mean intraindividual coefficient
supplementation of iodine, intake of thyroxine – TSH of variation (CV) between T1 and T2 as well as between T1, T2,
intake of allopurinol – uric acid and T3 (number of eligible players for T1 and T2 obviously higher
iron supplementation – ferritin than for all 3 sampling dates from T1 to T3; therefore slightly
magnesium supplementation – magnesium higher mean CVs can be expected for T1–T3). The mean CVs for
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creatine intake – creatinine erythrocytes, hemoglobin, and hematocrit were 2.6, 2.2, and 2.4
(T1 and T2), and 2.8, 2.5, and 2.7 (T1, T2, and T3), respectively.
Statistics For CK, CVs were 36.7 (T1 and T2) and 39.9 (T1, T2, and T3).
The statistical analysis was performed with the package Statis- Confidence intervals of T0–T3 overlap widely with each other
tica 6.1. Data are presented as medians and quartiles (in figures and with the population reference range. T1 might serve as the
for longitudinal analyses) or 95 % confidence intervals (for best reference sampling date because the number of players was
descriptive purposes). Lacking normal distribution for several the highest.
parameters (Kolmogorov-Smirnov test) indicated this procedure
to be adequate. Longitudinal analyses were conducted by use of Systematic changes over the season
a Friedman ANOVA. Within this analysis an α-error of p < 0.05 Over the course of the soccer season statistically significant
was considered statistically significant. To quantify variability of changes were detected in certain parameters: platelets, AST, cre-
each parameter, the mean intraindividual coefficient of variance atinine, urea, uric acid, sodium, potassium, and magnesium. The
(CV) was calculated. It represents the arithmetic average of all effect size of these changes, however, was small for all variables.
individual CVs (defined as standard deviation of a given variable Information about the longitudinal development is provided
divided by its mean value). It was intended to include as many of within the figures and in the second last column of ● ▶ Table 2
the professional soccer players in Germany as possible to come together with the number of players eligible for this analysis (at
as close to a complete sample as possible. A calculation of the all sampling dates).
necessary sample size was, thus, not carried out.
Discussion
Results ▼
▼ Repeated standardized blood sampling has never been con-
There were considerably different numbers of subjects for the 4 ducted over an entire competitive season in such a large number
sampling times (● ▶ Table 1). The main reasons for this inequality of elite professional soccer players. The results of this study indi-
were scheduling difficulties (at the onset of the preparation cate that routine blood parameters are robust against the con-
period when many squads were still incomplete; similarly founding influences of regular intense training and competition.
towards the end of the season when several travelling duties and To avoid misinterpretation of abnormal blood results, soccer-
coaches’ training preferences interfered), injuries, and non-com- specific reference values have to be used for very few parame-
pliance with the study requirements (e. g., deviation from the ters: CK (vastly different), AST, urea, and creatinine (all with only
required one training sessions on the day prior to sampling). modest deviations from population reference values). A careful
Results from non-compliant subjects were strictly eliminated application of these 95 % confidence intervals in similar team
from all analyses. ●▶ Fig. 1 provides a flow sheet that illustrates sports (handball, basketball, field hockey) seems possible. The
results of this study may further help in demarcating a normal
Compliance flow sheet range for routine blood parameters in highly active male ath-
letes who consult physicians and for whom routine blood values
n = 532 are determined to rule out disease. They can thus be relevant for
Competition on pre-sampling day or early training on
sampling day any physician consulted by a highly active patient who shows
n = 522 suspicious blood parameters.
Chronic disease An important reason for high CK values in soccer players are the
n = 520 game’s specific movements with its stop-and-go character and
Rehabilitation process after injury many direction changes which impose high eccentric biome-
n = 494 chanical strain on the working muscles leading to microinjuries
Less or more than one team training on day before
sampling and the release of CK from the cytosol [25, 39]. Typical soccer
n = 467 training and competition is obviously more prone to such mus-
cle damage than training in other disciplines like swimming [24]
Fig. 1 Flow sheet indicating the reasons for the elimination of players
or cycling. Wide 95 % confidence intervals up to 1 200 IU/l are
from statistical analysis.
partly due to single individuals with overproportionate CK
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
878 Clinical Sciences
5.8 1 400
1 327 U/I
5.6 5.71
5.07 5.63 5.64 1 200 308 U/I
1 217 U/I
5.56 107 U/I
4.51 4.92 4.91 331 U/I
5.4
Erythrocytes [×106/µL]
CK (U/L)
5.0
4.8 600
4.6 400
4.4
200
4.2
T0 T1 T2 T3 **
0
[n=215] [n=320] [n=226] [n=186] T0 T1 T2 T3
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[n=211] [n=292] [n=221] [n=158]
17.5
17.0 Fig. 3 Course of creatine kinase (CK) during the season (sampling times
16.9 from baseline T0–T3). Open squares and hatched areas indicate median
16.5 15.4 16.8
15.1 16.6 and 95 % CI for each sampling date (n given at the x-axis). Open circles
13.5 16.5
Hemoglobin [g/dL]
16.0 13.7 15.1 and whiskers stand for median and quartils of those players eligible
14.9 13.4
13.6 for longitudinal analysis (n = 26) revealing a significant trend towards
15.5
increased values over the season (p = 0.001; ** for sampling dates with
15.0 significantly different values from T0; Wilcoxon test). Numbers in the
figure refer to median (middle), upper (top) and lower (bottom) border of
14.5 the 95 % confidence interval.
14.0
13.5 II) muscle fibres might also tend to higher CK values [40]. In this
13.0 study 15 % of the players with CK values above 800 U/l were of
T0 T1 T2 T3
[n=215] [n=320] [n=226] [n=186] African origin (in contrast to 5.4 % of the entire study sample).
Interestingly, recent findings within a mixed athlete population
55
51.0 led to very similar reference intervals: 82–1 083 U/l [24] under-
46.0
lining the potential applicability of our results for athletes from
41.4 47.7 47.5
47.1 related sport disciplines.
50 42.7 42.6
43.0
39.0 38.2 The most frequently given reason for increased urea values in
Hematocrit [%]
38.9
elite athletes is their training volume associated with some
45 degree of glyconeogenesis that leads to degradation of structural
or functional proteins [12, 38]. Those amino acids that are not
utilized for energy metabolism are mainly eliminated through
40 the kidneys after metabolization to urea. Too low fluid intake
and kidney disease as alternative explanations seem unlikely –
*** *** *** even more without indications from medical history.
35 Slightly higher creatinine values than in the non-athletic popu-
T0 T1 T2 T3
[n=215] [n=320] [n=226] [n=186] lation are in line with existing literature [1]. Reasons for high
creatinine concentrations include increased muscle mass lead-
Fig. 2 Course of erythrocytes (top left), hemoglobin (top right), and ing to more creatinine turnover than usual [2, 35] and creatine
hematocrit (bottom) during the season (sampling times from baseline
intake [15]. It may be assumed that our recording of supplemen-
T0–T3). Open squares and hatched areas indicate median and 95 % CI
tal creatine intake was not complete because current reports
for each sampling date (n given at the x-axis). Open circles and whiskers
stand for median and quartils of those players eligible for longitudinal about creatine intake in athletic populations indicate more fre-
analysis (n = 39 for each parameter). A significant trend over the season quent use than self-reported in our study. Although not listed as
was detected for hematocrit only (p = 0.035; *** for sampling dates with a prohibited substance, creatine might enhance performance in
significantly different values from T0; Wilcoxon test). Erythrocytes and sports with repeated high-intensity character like soccer [16].
hemoglobin did not show significant changes during the season (p = 0.15 Given the present critical discussion about doping issues in elite
and p = 0.16, respectively). Numbers at the top of the hatched areas refer sport, some players might have been reluctant to admit creatine
to median (middle), upper (top) and lower (bottom) border of the 95 %
use (reported prevalence in the present study: only 0.6 %). How-
confidence interval.
ever, neither from the questionnaires nor from additional club
physician information any indications for creatine use of rele-
vant scale have arisen.
increases. However, it is well known that higher permeability of There is no obvious explanation for the observed systematic
muscle cell membranes exists in certain individuals increase in potassium from T0 to all sample times during the
[11, 26, 27, 31]. Some ethnic groups seem to be more frequently season. It is well known that potassium levels are increased
affected, and athletes with high percentages of fast twitch (type acutely during and after exercise [18]. But little is known about
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
Clinical Sciences 879
11
39
40
40
40
12
40
40
40
40
39
40
40
31
12
40
cell membranes has been observed in athletes but this finding
n
Trend would rather be compatible with lower potassium resting levels
0.119
0.032
α-error
[20]. On the other hand, the frequent use of electrolyte drinks
0.02
0.46
0.02
0.14
0.02
0.27
0.05
< 0.01
0.01
0.22
< 0.01
0.01
0.11
0.01
and improved food quality compared to off-season might favour
higher potassium blood levels. Although “seasonal pseudohy-
T1–T3
11.5
11.5
29.3
20.3
17.7
16.6
21.7
13.4
1.5
8.5
9.2
6.3
6.2
4.3
6.9
CV
10.7
10.5
20.5
18.8
10.0
16.8
15.6
15.3
11.8
1.6
8.1
9.0
6.6
5.8
3.9
6.5
CV
187
187
167
153
186
187
152
186
187
187
152
187
187
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observed after endurance training [30]. Although soccer is not a
0.75–1.30
30.7–81.4
0.78–0.98
0.73–3.50
1.00–3.49
3.81–5.18
125–238
142–331
138–144
59–162
17–155
3.2–8.6
4.0–7.2
18–63
13–49
24–55
T3
49.3
1.00
4.34
0.87
1.66 son have been described [21]. It is likely that such seasonal
177
108
210
141
5.4
5.5
29
23
54
37
240
240
240
157
166
226
240
240
240
163
235
240
240
212
240
ble blood lipid profile. In this study, low total cholesterol was
0.77–1.31
28.3–85.8
1.00–5.89
3.86–5.27
0.79–1.01
0.58–4.68
137–148
56–166
18–157
3.7–9.0
4.0–7.4
95 % CI
20–63
13–53
25–53
T2
49.0
1.00
4.43
0.89
1.63
176
104
212
142
5.4
5.7
58
36
323
323
323
246
246
320
323
323
323
321
244
323
323
298
322
31.6–82.1
1.00–5.39
3.68–5.06
0.75–0.99
0.61–3.64
137–148
59–172
18–154
3.6–8.2
3.9–7.2
95 % CI
20–60
13–46
26–53
51.7
1.00
4.32
0.87
1.61
170
105
217
142
5.7
5.5
30
24
36
58
216
216
216
178
164
215
216
216
216
216
176
215
216
216
212
33.2–77.6
1.00–4.14
3.46–4.74
0.78–0.98
0.66–3.67
128–252
137–339
137–146
60–171
14–174
3.1–9.5
4.2–7.8
25–52
18–57
14–51
T0
1.06
51.9
1.00
3.93
0.88
1.66
104
222
140
5.9
5.8
35
26
24
60
140–360
135–145
4.0–10.0
0.75–1.0
18–360
3.6–8.2
3.6–4.8
0.4–4.2
to proceed.
19–44
< 5.1
< 50
< 50
▼
Within applied studies there is always some kind of trade-off
creatinine [mg/dL]
platelets [x103/μL]
Mg + + [mmol/L]
Na + [mmol/L]
ferritin [μg/L]
urea [mg/dL]
K + [mmol/L]
TSH [mIU/L]
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
880 Clinical Sciences
longitudinally comparing routine blood results. This is why it clubs together with their medical staff who took care that on-
was decided to present uncorrected measurements. However, a site conduction of this study worked perfectly. Parts of this manu-
correction according to Dill and Costill ([5]; not presented) script have been presented in oral form at the German Congress
revealed no relevant differences from the reported results. In of Sports Medicine 2009 in Ulm, Germany.
addition, blood screening in professional soccer players is often
carried out with less rigorous control of sampling time, training References
schedule and nutrition than in the present study. But we felt that 1 Banfi G, Del Fabbro M, Lippi G. Creatinine values during a competitive
only strict elimination of all samples taken from players without season in elite athletes involved in different sport disciplines. J Sports
Med Phys Fitness 2008; 48: 479–482
sufficient compliance to study requirements guaranteed compa-
2 Banfi G, Del Fabbro M, Lippi G. Relation between serum creatinine and
rability to population reference values. Obviously, this proce- body mass index in elite athletes of different sport disciplines. Br J
dure reduced the number of samples for our calculations Sports Med 2006; 40: 675–678
considerably. To some degree, control of compliance relied upon 3 Banfi G, Del Fabbro M, Mauri C, Corsi MM, Melegati G. Haematological
parameters in elite rugby players during a competitive season. Clin
the truth of questionnaire answers, of course. Particularly, the Lab Haematol 2006; 28: 183–188
documentation of supplementation might have been incom- 4 Bangsbo J, Norregaard L, Thorso F. Activity profile of competition soc-
plete in some cases. cer. Can J Sport Sci 1991; 16: 110–116
5 Dill DB, Costill DL. Calculation of percentage changes in volume of
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
It is impossible to completely isolate chronic effects of training
blood, plasma, and red cells in dehydration. J Appl Physiol 1974; 37:
and competition on blood values from acute ones. In the present 247–248
study, it cannot be excluded that changes in some parameters 6 Durstine JL, Grandjean PW, Davis PG, Ferguson MA, Alderson NL, DuBose
represent rather acute effects arising from training or competi- KD. Blood lipid and lipoprotein adaptations to exercise: a quantitative
analysis. Sports Med 2001; 31: 1033–1062
tion during the days before sampling than chronic ones from the
7 El-Sayed MS. Effects of exercise and training on blood rheology. Sports
accumulation of such loads. This is particularly evident for CK Med 1998; 26: 281–292
values. Also, T0 was not free from acute influences because sev- 8 Fallon KE. Clinical utility of blood tests in elite athletes with short
eral players might have trained on an individual basis on the term fatigue. Br J Sports Med 2006; 40: 541–544
9 Fallon KE. Utility of hematological and iron-related screening in elite
days prior to their first club training session.
athletes. Clin J Sport Med 2004; 14: 145–152
In recent years, there has been an increasing awareness of sub- 10 Gabriel H, Schwarz L, Born P, Kindermann W. Differential mobilization
stance abuse, i. e., doping, in elite sport. There is never a com- of leucocyte and lymphocyte subpopulations into the circulation dur-
plete certainty that study results from elite athletes like in the ing endurance exercise. Eur J Appl Physiol 1992; 65: 529–534
11 Haralambie G. Neuromuscular irritability and serum creatine phos-
present study have not been affected by doping substances/pro- phate kinase in athletes in training. Int Z Angew Physiol 1973; 31:
cedures. But we found no indications for such misbehaviour. 279–288
None of the participating players had ever tested positive. In 12 Haralambie G, Berg A. Serum urea and amino nitrogen changes with
exercise duration. Eur J Appl Physiol 1976; 36: 39–48
addition, there were no suspicious blood values; e. g., high liver
13 Harriss DJ, Atkinson G. Update – Ethical Standards in Sport and Exer-
enzymes in combination with low HDL cholesterol (sometimes cise Science Research. Int J Sports Med 2011; 32: 819–821
seen under anabolic steroids) or frequent elevated values for 14 Herrmann M, Scharhag J, Miclea M, Urhausen A, Herrmann W, Kinder-
hemoglobin or hematocrit. Hemoglobin values above 17 g/dl mann W. Post-race kinetics of cardiac troponin T and I and N-terminal
pro-brain natriuretic peptide in marathon runners. Clin Chem 2003;
were present in 4 players at T0, in 5 at T1, and in 0 at T2 and T3,
49: 831–834
respectively. However, reticulocytes were not determined. 15 Jackson KA, O’Rourke KM, Kark A, Kennedy GA. Artefactual elevation of
Together with other hematological indices their number and its creatinine due to creatine water supplements. Med J Aust 2010; 193:
changes can be indicative of recent erythropoietin abuse or 616–617
16 Law YL, Ong WS, GillianYap TL, Lim SC, Von Chia E. Effects of two and
blood doping [23, 28]. five days of creatine loading on muscular strength and anaerobic
Reference values for the general population were taken from the power in trained athletes. J Strength Cond Res 2009; 23: 906–914
most common laboratory textbook in Germany. However, for 17 Malm C, Ekblom O, Ekblom B. Immune system alteration in response
to increased physical training during a five day soccer training camp.
single blood parameters there might be slightly deviating refer-
Int J Sports Med 2004; 25: 471–476
ence ranges in other populations [32] due to different genetic 18 Marcos E, Ribas J. Kinetics of plasma potassium concentrations during
make-up or other socio-ecological circumstances. However, they exhausting exercise in trained and untrained men. Eur J Appl Physiol
do not relevantly affect our interpretation of the study results 1995; 71: 207–214
19 McDonald CA. Enzyme levels after running. JAMA 1981; 246: 40–41
because the number of non-Caucasians was low in our sample
20 McKenna MJ, Harmer AR, Fraser SF, Li JL. Effects of training on potas-
and all these professional players typically live under comforta- sium, calcium and hydrogen ion regulation in skeletal muscle and
ble circumstances. blood during exercise. Acta Physiol Scand 1996; 156: 335–346
It can be concluded that there is a profound effect of elite soccer 21 McMillan K, Helgerud J, Grant SJ, Newell J, Wilson J, Macdonald R, Hoff
J. Lactate threshold responses to a season of professional British youth
training and competition on plasma volume and CK only. Devia- soccer. Br J Sports Med 2005; 39: 432–436
tions in all other values can be interpreted similar to the general 22 Meyer T, Gabriel HHW, Rätz M, Müller HJ, Kindermann W. Anaerobic
population even in highly active athletes. There are a number of exercise induces moderate acute phase response. Med Sci Sports Exerc
parameters that should not be repeatedly determined for rou- 2001; 33: 549–555
23 Morkeberg J, Belhage B, Ashenden M, Borno A, Sharpe K, Dziegiel MH,
tine screening purposes without clinical indication in athletes. Damsgaard R. Screening for autologous blood transfusions. Int J Sports
Med 2009; 30: 285–292
24 Mougios V. Reference intervals for serum creatine kinase in athletes.
Br J Sports Med 2007; 41: 674–678
Acknowledgements 25 Newham DJ, Jones DA, Edwards RH. Plasma creatine kinase changes
▼ after eccentric and concentric contractions. Muscle Nerve 1986; 9:
This study was funded by the Deutsche Fußball Liga (DFL; Ger- 59–63
man Football League) which served as a sponsor only (no influ- 26 Nicholson GA, Morgan G, Meerkin M, Strauss E, McLeod JG. The creatine
kinase reference interval. An assessment of intra- and inter-individual
ence on study conduction). There has been no further funding. variation. J Neurol Sci 1985; 71: 225–231
We would like to thank all team physicians of the participating
Meyer T, Meister S. Routine Blood Parameters in … Int J Sports Med 2011; 32: 875–881
Clinical Sciences 881
27 Noakes TD. Effect of exercise on serum enzyme activities in humans. 34 Stolen T, Chamari K, Castagna C, Wisloff U. Physiology of soccer – an
Sports Med 1987; 4: 245–267 update. Sports Med 2005; 35: 501–536
28 Parisotto R, Gore CJ, Hahn AG, Ashenden MJ, Olds TS, Martin DT, Pyne 35 Swanimathan R, Major P, Snieder H, Spector T. Serum creatinine and
DB, Gawthorn K, Brugnara C. Reticulocyte parameters as potential fat-free mass (lean body mass). Clin Chem 2000; 46: 1695–1696
discriminators of recombinant human erythropoietin abuse in elite 36 Thomas L. Labor und Diagnose (Laboratory and diagnosis). TH Books,
athletes. Int J Sports Med 2000; 21: 471–479 Frankfurt 2008
29 Scharhag J, George K, Shave R, Urhausen A, Kindermann W. Exercise- 37 Tucker AM, Vogel RA, Lincoln AE, Dunn RE, Ahrensfield DC, Allen TW,
associated increases in cardiac biomarkers. Med Sci Sports Exerc Castle LW, Heyer RA, Pellman EJ, Strollo PJ Jr, Wilson PW, Yates AP.
2008; 40: 1408–1415 Prevalence of cardiovascular disease risk factors among National Foot-
30 Schmidt W, Prommer N. Effects of various training modalities on blood ball League players. JAMA 2009; 301: 2111–2119
volume. Scand J Med Sci Sports 2008; 18 (Suppl 1): 57–69 38 Urhausen A, Kindermann W. Biochemical monitoring of training. Clin
31 Schwartz PL, Carroll HW, Douglas JSJ. Exercise-induced changes in J Sport Med 1992; 2: 52–61
serum enzyme activities and their relationship to max VO2. Int Z 39 Warren GL, Lowe DA, Armstrong RB. Measurement tools used in the
Angew Physiol 1971; 30: 20–33 study of eccentric contraction-induced injury. Sports Med 1999; 27:
32 Sharpe K, Hopkins W, Emslie KR, Howe C, Trout GJ, Kazlauskas R, Ash- 43–59
enden MJ, Gore CJ, Parisotto R, Hahn AG. Development of reference 40 Wong ET, Cobb C, Umehara MK, Wolff GA, Haywood LJ, Greenberg T,
ranges in elite athletes for markers of altered erythropoiesis. Haema- Shaw ST Jr. Heterogeneity of serum creatine kinase activity among
tologica 2002; 87: 1248–1257 racial and gender groups of the population. Am J Clin Pathol 1983;
33 Sinclair D, Briston P, Young R, Pepin N. Seasonal pseudohyperkalaemia. 79: 582–586
J Clin Pathol 2003; 56: 385–388
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